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    Prepare Romania: study protocol for a randomized controlled trial of an intervention to promote pre-exposure prophylaxis adherence and persistence among gay, bisexual, and other men who have sex with men
    (BMC, part of Springer Nature, 2024-07-10) Lelutiu-Weinberger C; Filimon ML; Zavodszky AM; Lixandru M; Hanu L; Fierbinteanu C; Patrascu R; Streinu-Cercel A; Luculescu S; Bora M; Filipescu I; Jianu C; Heightow-Weidman LB; Rochelle A; Yi B; Buckner N; Golub SA; van Dyk IS; Burger J; Li F; Pachankis JE
    BACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) represent a high-risk group for HIV transmission in Romania, yet they possess few resources for prevention. Despite having no formal access to pre-exposure prophylaxis (PrEP) through the health system, GBMSM in Romania demonstrate a high need for and interest in this medication. In anticipation of a national rollout of PrEP, this study tests the efficacy of a novel strategy, Prepare Romania, that combines two evidence-based PrEP promotion interventions for GBMSM living in Romania. METHODS: This study uses a randomized controlled trial design to examine whether GBMSM living in Romania receiving Prepare Romania, a culturally adapted counseling and mobile health intervention (expected n = 60), demonstrate greater PrEP adherence and persistence than those assigned to a PrEP education control arm (expected n = 60). Participants from two main cities in Romania are prescribed PrEP and followed-up at 3 and 6 months post-randomization. PrEP adherence data are obtained through weekly self-report surveys and dried blood spot testing at follow-up visits. Potential mediators (e.g., PrEP use motivation) of intervention efficacy are also assessed. Furthermore, Prepare Romania's implementation (e.g., proportion of enrolled participants attending medical visits, intervention experience) will be examined through interviews with participants, study implementers, and healthcare officials. DISCUSSION: The knowledge gained from this study will be utilized for further refinement and scale-up of Prepare Romania for a future multi-city effectiveness trial. By studying the efficacy of tools to support PrEP adherence and persistence, this research has the potential to lay the groundwork for PrEP rollout in Romania and similar contexts. Trial registration This study was registered on ClinicalTrials.gov, identifier NCT05323123 , on March 25, 2022.
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    Resisting stigma: the role of online communities in young mothers' successful breastfeeding.
    (BioMed Central Ltd, 2024-03-06) Severinsen C; Neely E; Hutson R
    BACKGROUND: Breastfeeding initiation and continuation rates are shaped by complex and interrelated determinants across individual, interpersonal, community, organisational, and policy spheres. Young mothers, however, face a double burden of stigma, being perceived as immature and incompetent in their mothering and breastfeeding abilities. In this study, we aimed to understand the experiences of young mothers who exclusively breastfed for six months and beyond and explore their experiences of stigma and active resistance through social media. METHODS: In 2020, in-depth telephone interviews about breastfeeding experiences were conducted with 44 young mothers under age 25 in Aotearoa New Zealand who breastfed for six months or longer. Participants were recruited via social media. Interviews were audio-recorded, transcribed and analysed thematically. RESULTS: Analysis yielded four themes on young mothers' negotiation of breastfeeding and support. The first three themes revealed young mothers' encounters with socio-cultural contexts. They faced negative judgments about maturity and competence, adverse guidance to supplement or cease breastfeeding, and an undermining of their breastfeeding efforts. The fourth theme showed how young mothers sought alternative support in online environments to avoid negative interactions. Online spaces provided anonymity, convenience, experiential knowledge and social connections with shared values. This facilitated identity strengthening, empowerment and stigma resistance. CONCLUSION: Our research highlights the importance of online communities as a tool for young mothers to navigate and resist the societal stigmas surrounding breastfeeding. Online spaces can provide a unique structure that can help counteract the adverse effects of social and historical determinants on breastfeeding rates by fostering a sense of inclusion and support. These findings have implications for the development of breastfeeding promotion strategies for young mothers and highlight the potential of peer support in counteracting the negative impacts of stigma. The research also sheds light on the experiences of young mothers within the health professional relationship and the effects of stigma and cultural health capital on their engagement and withdrawal from services. Further research should examine how sociocultural barriers to breastfeeding stigmatise and marginalise young mothers and continue to reflect on their socio-political and economic positioning and how it can exacerbate inequities.
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    Living large : the experiences of large-bodied women when accessing general practice services : a thesis presented in partial fulfillment of the requirements for the degree of Master of Philosophy (Nursing) at Massey University, Palmerston North, New Zealand
    (Massey University, 2011) Russell, Nicola
    The ‘obesity epidemic’ of the past two decades has resulted in numerous studies reporting higher levels of stigma and discrimination experienced by obese/overweight women, both within the health care system and society in the main. Despite general practice being the most utilised point of access for health care services, there has been very little international or national exploration of the experiences of large-bodied women accessing these services. Utilising a qualitative, descriptive research design, this post-structuralist feminist study has enabled a group of large-bodied women to express their stories of accessing general practice services. Eight self identified large-bodied women volunteered to participate in semi-structured face-to-face interviews. Thematic analysis identified seven themes: Early experiences of body perception, Confronting social stereotypes, Contending with feminine beauty ideals, Perceptions of health, Pursuing health, Respecting the whole person and Feeling safe to access care. The women in this study articulated broader interpretations of health and well-being than those teachings reproduced within dominant bio-medical and social discourses of obesity. When these women’s personal context, beliefs and values are silenced by the health care provider, the rhetoric of health care professional claims of patient-centred care has given way to these women experiencing stigmatisation and a sense of ambiguity about general practice services. However, when space is given for multiple interpretations of obesity to exist within the patient-health care provider relationship, these women feel respected, their health needs are satisfied and they are more comfortable to engage in health screening services. Resisting the powerful socio-cultural milieu which supports the superiority of a slim female body as a signifier of both health and beauty presents a challenge for health care professionals to negotiate. I contend however, that giving consideration to the perspectives of large-bodied women and critically reflecting upon one’s own personal beliefs and attitudes about the overweight/obese, presents an opportunity to ensure clinical practice for this population is truly patient-centred.
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    The unique experiences of Maori adoptive mothers in the 'closed stranger' adoption system : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology, Massey University, Palmerston North, Aotearoa/New Zealand
    (Massey University, 2009) Perkins, Valerie Maruru
    'Closed stranger' adoption in Aotearoa / New Zealand from approximately 1940 to 1990 involved the practice of a complete break between the birth mother and her child and the legal transfer of the child to adoptive parents. In Aotearoa / New Zealand between 1940 and 1990, 108,899 adoptions took place, and most consisted of ‘closed stranger’ adoptions. These adoptions have caused much joy as well as some heartache for parties involved in the experience namely, birth mothers, adoptees and adoptive mothers and their whānau. This thesis reports original research which aims to investigate the unique experiences of Māori adoptive mothers in the 'closed stranger' adoption period and enable the impact of legal adoption on these Māori women who have not previously warranted research, to be valued. A qualitative methodology, Māori-centred research and unstructured kanohi ki te kanohi (face to face) interviews were utilized to gather data from six Māori adoptive mothers. The intention of Māori centred research as its name suggests, is to locate Māori people and Māori knowledge at the centre of the research action. A thematic analysis utilizing interpretative phenomenological analysis (IPA) was used. The unique experiences of Māori women legally adopting in the ‘closed stranger’ adoption system were about whānau business, and grouped under that superordinate theme were experiences of ‘not blood’, land succession, naming and caring for whānau. The stigma of adoption resonated throughout the women’s narratives. As well, most of these Māori adoptive mothers found that they experienced ‘closed stranger’ adoption as a ‘rollercoaster of emotions’.
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    Shame on who? : experiential and theoretical accounts of the constitution of women's shame within abusive intimate relationships : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Sociology at Massey University
    (Massey University, 2009) Jury, Angela Jean
    This feminist project explores the experiential accounts of twenty-five women who have lived through abuse within their intimate relationships. Their stories, gathered through a series of semi-structured face-to-face interviews intended to elicit accounts of resilience were saturated with emotion-talk, especially shame-talk. To address questions of the relationship between these accounts and theoretical accounts of abuse, and shame the women’s texts were engaged in an analytic dialogue with feminist knowledges of abuse against women, Erving Goffman’s sociological understandings of shame, stigma and mortification of the self, Thomas Scheff’s sociological theory of shame and social bonds, and feminist poststructuralist understandings around the constitution of human subjectivity. These conversations enabled development of a conceptual representation of the special and highly specific form of social bonding experienced by victims of abuse within intimate relationships. This bonding begins with processes of mortification of the self, the gradual erosion of a sense of self through the systematic imposition of various shaming and shameful actions. These processes take place within a specific social context created through the constitutive power of dominant discourses of gender, heterosexual coupledom, matrimony and motherhood which work to shape the lives of individual women. Because of the specific ways in which these discourses currently operate within Aotearoa New Zealand they result in the constitution of a narrow range of tightly prescribed subject positions available to victims of intimate partner abuse. This analysis leads to an argument that women’s inability to ‘do’ motherhood or intimate partnership in line with dominant discourses of mothering and relationships (because these simply cannot be achieved within an abusive context), opens them to the debilitating effects of shame. Shame, both actual and threatened, promotes silence, isolation and dangerous private spaces as women seek to protect themselves from its painful experience. I argue that it is therefore crucial to promote the availability of discursive positioning for women living through abuse which offers non-shaming and realistic choices.
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    From experiencing social disgust to passing as normal : self-care processes among Thai people suffering from AIDS : a thesis presented in fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Palmerston North, New Zealand
    (Massey University, 2008) Siriwatanamethanon, Jirapa
    AIDS is a chronic disease that seriously affects health, emotions, social relations and household economy. People living with HIV/AIDS experience great suffering, stigmatisation and discrimination from other people around them because they know that it is incurable, contagious, evokes social disgust and is a complex disease requiring life-long self-care. This researcher explored ways people with HIV/AIDS take care of their health and manage their lives in the context of stigma and discrimination. A grounded theory study was conducted with 30 participants with HIV/AIDS, in Mahasarakham Province, Thailand. Participants were recruited from an HIV/AIDS day care clinic and by snowball sampling. Data were gathered through in-depth interviews, participant observations and field notes made during home visits. Interviews were tape recorded, then transcribed verbatim. “From experiencing social disgust to passing as normal” was generated inductively from the data as the basic social psychological process of Thai people living with HIV/AIDS. From experiencing social disgust to passing as normal comprised four categories: being HIV/AIDS, making choices, keeping well and feeling empowered. The category “being HIV/AIDS”- discovering the meaning of having HIV/AIDS, comprises four concepts: being diagnosed with HIV/AIDS, being stigmatised, suffering, and learning about HIV/AIDS. The category “making choices”- to live a normal life, involves three concepts: avoiding unhappy situations, getting remarried and seeking support. The category “keeping well”- maintaining emotional and physical health, includes eight concepts: religious practices, keeping a cheerful mind, self-treatment, taking care of the body, keeping the environment clean to prevent getting germs, healthy behaviours, getting healthcare services, and attention to, and concern about, medication. The last category “feeling empowered”- personal and social acceptance of illness, includes eight concepts: being encouraged, acknowledging the disease, social acceptance, tamjai, feeling proud of self, feeling good about life, feeling lucky and having hope. In the context of northeastern Thailand, successful management of HIV/AIDS was underpinned by participants making a transition from “experiencing social disgust” to “passing as normal” within their communities. The desire to live a normal life despite having HIV/AIDS motivated participants to undertake effective self-care in order to remain symptom free (thus avoiding visible signs of the disease), and to selectively disclose their illness to avoid the ongoing risk of stigma and discrimination. The findings of this study are useful in that they will provide Thai health professionals with a clearer conceptualisation of self-care among the Thai population. An inductively derived theory of self-care among Thai with HIV/AIDS can be applied and integrated by health professionals into the self-care models for people living with HIV/AIDS including models used in nursing education, research and practice.